The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the Treatment of Acute Bipolar Depression

Abstract

Objectives. These guidelines are based on a fi rst edition that was published in 2002, and have been edited and updated with the available scientifi c evidence until September 2009. Their purpose is to supply a systematic overview of all scientifi c evidence pertaining to the treatment of acute bipolar depression in adults. Methods. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientifi c rigor was categorised into six levels of evidence (A–F). As these guidelines are intended for clinical use, the scientifi c evidence was fi nally assigned different grades of recommendation to ensure practicability. Results. We identifi ed 10 pharmacological monotherapies or combination treatments with at least limited positive evidence for effi cacy in bipolar depression, several of them still experimental and backed up only by a single study. Only one medication was considered to be suffi ciently studied to merit full positive evidence. Conclusions. Although major advances have been made since the fi rst edition of this guideline in 2002, there are many areas which still need more intense research to optimize treatment. The majority of treatment recommendations is still based on limited data and leaves considerable areas of uncertainty.